Health Sector Reforms Powerpoint

7/30/2019 Health Sector Reforms Powerpoint

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Health Sector Reformsin

Karnataka State

By

Dr. H.SudarshanKaruna Trust


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Public Private Partnership

Partnership with Voluntary Organizations:

Entrusting Management of PHCs to Vos andPrivate Medical Colleges

Karuna Trust is managing 15 PHCs Goal is to manage one Good Practicing PHC in

all the 27 Districts

Tele Medicine project Asia Heart Foundation

and Karuna trust

Tribal ANMs Project

Innovations: VHCs, Rehabilitative Services


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The Task Force constituted by the Chief Minister

GO No HFW 545 CGM 99, Bangalore dt.14-12-1999

The terms of reference were to make recommendations for:

Improvement of Public Health;

Stabilization of the population;

Improve management and administration of the

Department;

Changes in the education system covering both Clinical and

Public Health.

And to monitorthe implementation of the recommendations.


Task Force on Health and Family Welfare


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12 Major Issues of Concern

1. Corruption

2. Neglect of Public

3. Distortions in Primary Health Care

4. Lack of Focus on Equity

5. Implementation Gap

6. Ethical Imperative


Final Report


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Final Report

12 Major Issues of Concern

7. Human Resource Development

8. Cultural Gap and Medical Pluralism

9. From Exclusivism to Partnership

10. Ignoring the Political Economy of Health

11. Research

12. Growing Apathy in the System


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Final Report

Contents

1. Equity in Health Care

2. Quality of Health Care3. Primary Health Care

4. Secondary and Tertiary Health Care

5. Public Health

6. Mental Health and Neurosciences

7. Nutrition

8. Women and Child Health


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Final Report

Contents

9. Population Stabilisation

10. Focus on Special groups

11. Health Promotion and Advocacy for Health

12. Human Resources Development for Health

13. Research in Health

14. Health Systems Management15. Health Financing

16. Rational Drug Management


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Final Report

Contents

17. Law and Ethics

18. Indian Systems of Medicine and Homoeopathy

19. Panchayat Raj and Empowerment of People20. Strengthening of Partnership

21. Multisectorality and Intersectoral Co-ordination

22. The Karnataka State Integrated Health Policy 2001

23. Vision 2020

24. Implementation of the Report

25. Major Recommendations and Expected Outcome


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Karnataka State Integrated Health Policy 2001 Vision, Mission & Goals

Comprehensive Health Policy which includes

Health Policy

Population policy

Drug policy

Nutrition policy

Education for Health Sciences Policy

Blood banking policy Policy on Control of Nutritional Anaemia

AIDS Prevention & Control Policy (draft)

ISM&H Policy (draft)

Pharmaceutical Policy


Final Report


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For Profit Private Sector

Out sourcing of Cleaning, Security andmaintenance Services

Contracting Private Doctor and Specialists

Contracting One Super Specialty Hospital OPEC Hospital, Raichur.


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Decentralization

Karnataka has Decentralized Democratic

System Panchayat Raj Institutions

Involvement of ZP and Taluka Panchayats

in Health

Decentralization of Administrative and

Financial Powers

VHCs IPP9 project


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Reforms related to Human

Resources

Appointment of Staff on Contractual basis

Multi-skilling of Health Personnel : CRS

course

Mandatory Pre-PG rural service

Formation of District Cadres

Creation of Taluka Health Officers Recruitment and Transfer Policy

transfers by counselling


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Reforms in Health Financing

User Fee Vs Token Fee

Establishment of Hospital Committees

Granting Autonomy to Hospitals & HealthInstitutions

Health Insurance:

1. KT UNDP Community Health Insurance

2. Yashaswini Scheme

3. Arogya Raksha Project


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Financial management Optimum utilisation of allocations

Delegation of financial powers Release of funds - timely issue of sanction

No budgetary cuts for Health Services

Adequacy of funds for maintenance of essential

needs

repairs, maintenance and efficient use ofassets

Community Insurance for health

Liability Insurance for doctors

Test Audit

Health Systems Management


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Re-organization & Re-structuring

of

Karnataka Health & Family

Welfare Department


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Division on the basis of functional responsibilities

Public Health

Medical (Curative) District Cadres

Constitution of Karnataka Health Services (KHS)

Reformulation of

Cadre/Recruitment/Structures/Rules

Health Systems Management


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State cadre (KHS)

PG qual. compulsory

Merit cum seniority

Medical Officer

PHC

Deputy DMO/RMO

Taluk Health Officer(THO)

AMOTaluka Hospital

DHO

PG in Public Health

DMO (DS)

PG in Clinical + Hos Adm

Programme Officer

MBBS min.qualification

PGs can also enter

DistrictCadre(ZPCadre)

Taluk

Medical Public Health

Community

Health Centre

Dist. Med Store

Dist. Maint Unit

Dist. Laboratory

Dist. HMIS Unit

CHART NO. 2

DEPARTMENT OF HEALTH & FAMILY WELFARE

ORGANISATIONAL STRUCTURE: PROPOSED

DISTRICT LEVEL

CHART NO 3


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Lady Medical Officer Medical Officer

Staff

Nurse

Pharmacist Lab Tech Sr. HA

(Female)

Sr. HA

(Male)

SDC Driver* Aya

JHA

(F)

TBA

VHW

AWW

JHA (M)JHA

(F)

JHA

(F)JHA (M) JHA

(F)

JHA

(F)JHA(M)

JHA

(F)

* Driver for PHCs which have vehicles

CHART NO. 3



DISTRICT LEAVEL, PRIMARY HEALTH CENTRE


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Taluk Health OfficerDPH Qualification

Senior Health Assistant

(Male & Female)

BHE's

(Shift from PHC

to Taluk Level)

Refractionists

(Shift from PHC

to Taluk Level)

ASO

(Statistics person must

for HMIS)

FDC Driver

CHART NO. 4



DISTRICT LEVEL

TALUK HEALTH OFFICE

CHART NO 7


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DHO

Prog Co-ordinator

RCH-PO

Vector -PO

TB - PO

FW - PO

LEP+STD/HIV

Blindness PO

HP- PO

Nutri

IEC

DSO

Entm Statis

District Hospital

District Laboratory

Microbiologist

Pathologist

Biochemist

Dt. Maint UnitCivil works

Vehicle maintenance

Equipment maint

Dt. Medical Store

Dt. HMIS Unit

DMO

Mental-PO

CVS-PO

Opth-PO

Onco-PO

AMOs

CHART NO. 7



STRUCTURE AT DISTRICT HEALTH OFFICES DHO & DMO


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DIRECTOR

PUBLIC HEALTH

Add. Director

AIDS

(KSPC)

Project Director

RCH & PHC

Add. Director

Health Promotion

AD (CMD)State Survey Off

Chief Acc.

OfficerAD-BMP

Urban PHCs

JD

AIDS

JD

RCH

JD

PHC

JD

IEC

JD

Nut

JD-Vect

Borne Dis

JD

TB

JD

Leprosy

JD

Vaccine

JD

Lab

DD

KFD

DD

Dis Surv

CHART NO. 9



STATE LEVEL


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DIRECTOR

MEDICAL

JD

Medical

JD

GMS

JD-Hosp

North

JD-Hosp

South

JD-Trau-

Eme Med

JD

Ophthal(MINTO)

JD-CVS

& Diabet

JD-Dent

Health

JD-MH(NIMHANS)

JD-Onco(KIDWAI)

Addl Director

Medical

Addl Director

NCD CAO

CHART NO. 10



STATE LEVEL


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DIRECTOR

Ext. Aided Projects

DIRECTOR

Procurement & Maint

AD (SPC)

Planning & Monitor

Joint Director

Planning

Joint Director

HMIS

Joint Director

Procurement

JD-Bio-Medical

Equip Maintenance

Superintendent Eng

Civil

DD-Law & Ethics

(Forensic Medicine)Civil Engineering.

Staff

as in KHSDP

Secretary PWD

CHART NO. 11



STATE LEVEL

CHART NO 12


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DIRECTOR

ISM&H

Directorate level

JD

Med Edu

JD

ISM&H

Admin

Officer

Accounts

Officer

Ast Drug

Controll

Principals

Col & Hosp

DD

Ayurveda

DD

Unani

DD

Homoeo

DD

Nat & Yog

3 Drug-

Inspectors

Physician Gr I

District Hospital

Dt. ISM&H Officer

Phy Gr II

Hosp & Disp

DDPharmacy

Div DDs

?

Aided

Col & Hos

CHART NO. 12


ORGANISATIONAL STRUCTURE : PROPOSED

DIRECTORATE OF ISM&H


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PRINCIPAL

SECRETARY

Governing Board

Director

Selection PostSIHFW

(Autonomous)

Commissioner /

DGHS

Directorate

Joint Director

Training

Joint Director

Research

(Social Scientist)

Specialists

Communication

Health MgtRCH/NCD

Deputy Director

Course Content

Deputy Director

Training

Principals RHFWTC/DTC

ANM Training Centres

CHART NO. 13


ORGANISATIONAL STRUCTURE : PROPOSED

STATE INSTITUTE OF HEALTH & FAMILY WELFARE (AUTONOMOUS)

CHART NO 14


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DRUGS CONTROLLER

ADDITIONAL DRUGS

CONTROLLER

Enforcement DivisionDrugs Testing Laboratory Pharmacy Education

Head

Quarters

Drugs Price

Control CellBl bank

& Intellig

Circle &

Dt. Off

Superintendent (Admn) -1

Superintendent (Lab) -1

Other Technical -7

OfficersJunior Chemists -30

Govt.

College of

Pharmacy

Board of

Examining

Authority

Dy. Drugs Controller - 8

Asst. Drugs Controller -19

Drugs Inspector -56

Principal & Chairman - 1

Member Secretary - 1

Professor - 6

Asst. Professor - 8

Lectures (Pharmacy Lect) -17

(Non Pharmacy) - 5

CHART NO. 14

DEPARTMENT OF HEALTH & FAMILY WELFARE ORGANISATIONAL STRUCTURE

DRUG CONTROL DEPARTMENT

CHART NO 15


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SECRETARY

MEDICAL EDUCATION

Director

Medical Education

Autonomous Teaching

Hospitals/Institutions

DEAN

BMC

DEAN

MMC

AD

Med Edu

DEAN

GDC

*Dir

RIO

Vice PrlBMC

Vice PrlMMC

Supr

Hos 1

Supr

Hos 2

Supr

Hos 3

Supr

Hos 4

Supr

Hos 5

Supr

Hos 6

Supr

Hos 7

JD

ME

Vice PrlGDC

CHART NO. 15



DEPARTMENT OF MEDICAL EDUCATION

PROFESSORS & HOD BMC / MMC

ASSOCIATE PROFESSORS

ASSISTANT PROFESSORS

LECUTRERS

REGISTRARS / TUTORS / DEMONSTRATORS/ RESIDENTS

* Regional Institute Ophthalmology (RIO) could be made into an Autonomous Institution

DD (ME) DD (DE)


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Autonom Hosp.

Drug Controller

SIHFW

Pop & Health Research

CAO

Finance

CVO

Vigilance

Director

Public Health

Director

Medical

Director

EAP

Director

Procurement /

Maintenance

NGO Cell

PRINCIPAL

SECRETARY

Commissioner / DGHS

Commission on

Health

Dir. ISM&H

Secretary (ME)

Autonomous Teaching

Hospital / Institute

Director (ME)

Joint Director

Special Groups

Additional Director

Planning

Additional Director

N. Karnataka

CHART NO. 8



STATE LEVEL


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Rational Drug Management

Optimization of Drug procurementquantification,

procedures Establishment of Standard Treatment Guidelines,

Essential Drug List and State Formulary.

Govt. Medical Stores/District Stores reorganisation

Drugs Control Department

Strengthening for effective

supervision.


Final Report


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Good GovernanceKarnataka Health Department

by

Dr.H. SudarshanVigilance Director

(Health,Education & Social Welfare)


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The Epidemic of Corruption in Health ServicesCorruption in Hospitals

a. Corruption in service delivery by thefollowing:

Ayaas/ward boys

Contract workers

Technicians

Administrative Staff

Nurses

Pharmacist

Doctors

Specialists

The Epidemic of Corruption in Health Services


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Various forms of Corruption by Doctors and Para

Medical Staff:

Private practice

Nursing Homes (owned by spouses, relatives &

business partners)

Referrals to Private Hospitals

Owning Pharmacies

Blood Banks

Excess of assets over income

The Epidemic of Corruption in Health ServicesCorruption in Hospitals


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Epidemic of Corruption in Health Services

Drugs Control Department

Lokayukta ride on Drugs control Departmentwide spread corruption - mamools

Manufacturing License: Inspection of units forfresh & renewal - less than 20%

Drugs collected during inspections Low 2268 samples declared Not of standard Quality

including 126 spurious drugs very fewprosecutions

No action initiated on those who suppliedspurious drugs to Health department


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Epidemic of Corruption in

Drugs Control Department Indiscriminate issue of Loan licenses & product

permissions to Loan Licensee

50% of the Medical shops do not have qualifiedpharmacists hardly 14 prosecutions

Violation of DPCO people of Karnataka havepaid nearly 100 crores in excess

Complaints given by public & institutions werenot attended.

Trading of blood by Unlicensed Blood Banks &chemists, HIV infected blood sold


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Corruption in Procurement of Drugs

Purchase of Non Essential DrugsNemisulide Tabs 18% of budget

IV fluids scam Bypassing HAL and

buying from PDPL Decentralized Corruption in Procurement

of drugs by Zilla Panchayaths buying

spurious and substandard drugs fromunlicensed manufacturers excess price.


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The Epidemic of Corruption in Health Services

Corruption in Civil Works: Construction of PHCs, CHCs,Taluka & District Hospitals and Repairs.

Corruption in Administration:at offices of District

Health, Directorate & Secretariat for the following

Recruitment & Postings,

Transfers & Promotions

Sanctioning Leave, Medical reimbursement

Monitoring Private Practice & Absenteeism

Suspension and Reinstating


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The Epidemic of Corruption in Health ServicesCorruption in Medical Education

Sanctioning New Colleges - Medical, Nursing &

ISM&H

Increasing seats of Nursing Colleges

Admissions

Examination: bribes for examiners-Undergraduate

& PGs

Recruitment of Teaching Staff Registration in KMC.


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Reforms for Good Governance in Health

Proactive Lokayukta

Consumer Forum

Transparency Act

Right to Information Bill

Training in Health & Hospital management

Leadership training

HMIS & e-Governance

Hospital & Health Committees


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THANK YOU

Health Sector Reforms Powerpoint

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